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Integrating Emotionally Focused Therapy

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Integrating Emotionally Focused Therapy Article The Family Journal: Counseling and Therapy for Couples and Families 2015, Vol. 23(4) 346-357 Integrating Emotionally Focused Therapy, ª The Author(s) 2015 Reprints and permission: Self-Compassion, and Compassion-Focused sagepub.com/journalsPermissions.nav DOI: 10.1177/1066480715601676 Therapy to Assist Shame-Prone Couples tfj.sagepub.com Who Have Experienced Trauma Mark Karris1 and Benjamin E. Caldwell1 Abstract Emotionally focused therapy (EFT) for couples in which one or both partners have a history of trauma and are shame prone presents unique challenges that can potentially impede the therapeutic process. Neff’s conceptualization of self-compassion and research has demonstrated the benefits of self-compassion for both oneself and interpersonally. Gilbert’s compassion-focused therapy (CFT; 2010) is an evidence-based, integrative approach that specifically works with trauma and chronic consequences of affect dysregulation and shame. This article reviews the empirical research on EFT, self-compassion, and CFT and includes a brief review of trauma and shame. This article also discusses various ways in which Neff’s conceptualization of self-compassion and Gilbert’s CFT can be integrated into EFT for the benefit of both the EFT therapist and couples taken over by trauma and shame. Keywords emotionally focused therapy, self-compassion, trauma, shame, mindfulness, dysregulation, compassion-focused therapy There has been a recent increase in research regarding self- Emotionally Focused Therapy compassion since Kristin Neff (2003a), a researcher from the University of Texas at Austin, operationalized the concept Although other people are often the source of trauma (e.g., in war, abuse, or assault), it is within safe and significant interper- and created a scale to measure its constructs. A growing body sonal relationships that trauma victims can heal and recover of research indicates that self-compassion is linked to intra- (Herman, 1992; van der Kolk, McFarlane, & Weisaeth, 1996). personal (Gilbert, 2005, 2014; Neff, 2003a; Neff, Kirkpatrick, Relationships are vital for human existence and necessary ‘‘from & Rude, 2007; Neff & McGehee, 2010) and interpersonal cradle to the grave’’ (Bowlby, 1982). Emotional resilience and (Neff & Beretvas, 2013; Neff & Pommier, 2013; Yarnell & a fortified sense of self cannot exist in the absence of relation- Neff, 2013) benefits. Another model with extensive research ships (Mikulincer, 1995), especially in the aftermath of trauma is Gilbert’s compassion-focused therapy (CFT). CFT is a model of psychotherapy that places self-compassion at the (Mikulincer, Shaver, & Horesh, 2006). EFT, which is one of the most empirically supported approaches to couple therapy core of its approach and was developed for individuals with (Lebow, Chambers, Christensen, & Johnson, 2012), takes trauma backgrounds struggling with psychological problems advantage of the healing power and primacy of relationships linked to self-criticism and shame (Gilbert, 2010). This theo- and is currently used as an efficacious treatment approach with retical article will explore the integration of self-compassion couples affected by trauma (S. M. Johnson, 2002, 2004; Macin- and CFT with emotionally focused therapy (EFT; S. M. John- tosh & Johnson, 2008). son, 2002), to assist couples overcome the impact of trauma in EFT is an experiential approach to couples therapy that Sue couples’ therapy. Self-compassion practices and principles will be used for the explicit purpose of regulating negative Johnson and Leslie Greenberg developed in the early 1980s (Greenberg & Johnson, 1986; S. M. Johnson & Greenberg, and constrictive affect with couples to move toward the pre- 1995). EFT emphasizes the emotional attachment bond ferredstrategyofcoregulationof difficult emotional states (Beckes & Coan, 2011; S. M. Johnson, 2004; Sbarra & Hazan, 2008). This article will include an exploration into how self- 1 compassion–based interventions can reduce both couple and Alliant International University, San Diego, CA, USA therapist shame, which is a particular affective state that can Corresponding Author: impede the trauma work essential to EFT (S. M. Johnson & Mark Karris, 13122 Sienna Court San Diego, CA 92129, USA. Williams-Keeler, 1998; Macintosh & Johnson, 2008). Email: [email protected] Downloaded from tfj.sagepub.com at University of Texas Libraries on June 3, 2016 Karris and Caldwell 347 between couples and is grounded in attachment, humanistic, posttraumatic stress disorder (PTSD; Amir & Kaplan, 1996) systemic, and experiential theories (S. M. Johnson, 2004). Fun- or other subclinical levels of emotion dysregulation. damentally, EFT is an attachment-based model. While Bowlby EFT is gaining traction with regard to being efficacious for (1982) and others (e.g., Ainsworth, Blehar, Waters, & Wall, couples dealing with trauma and who meet criteria for PTSD 1978) applied attachment theory to children, S. M. Johnson and (Greenman & Johnson, 2012; S. M. Johnson, 2004). For Greenberg applied it to couples. Our needs for secure attach- instance, Naaman (2008) demonstrated a significant reduction ment do not change over time, S. M. Johnson and Greenberg in PTSD symptoms using EFT with couples in which the wife argue, but rather are refocused on the romantic partner as the suffered from breast cancer. War veterans had a significant primary attachment figure. EFT focuses on creating a safe and decrease in PTSD symptoms after they engaged in an average secure attachment bond with that partner. of 30 sessions of EFT (Weissman et al., 2011). In another study, Distressed couples typically come into therapy over- EFT successfully decreased PTSD symptoms experienced by 10 whelmed by intense emotions that have the capacity to keep highly distressed couples in which one partner was a survivor of them stuck in a pernicious pattern of negative interactions childhood sexual abuse (MacIntosh & S. M. Johnson, 2008). (S. M. Johnson, 2004). In the process of EFT, emotions that are McLean and Hales (2010) conducted a case study using EFT typically constricted, unprocessed, and hidden from the self with couples in which one partner was terminally ill and the and the partner, such as fear, sadness, loneliness, shame, and other partner had a history of childhood trauma. EFT was shown anxiety, are tenderly and vulnerably brought out into the open to help the couple navigate through the complications of the ter- and shared. As these new vulnerable emotions are experienced minal illness and help lessen the complications of spousal and processed, they can create new healing emotional experi- bereavement. Halchuk, Makinen, and Johnson (2010) showed ences for the couple that transcend the therapy office and con- that EFT was also effective at helping couples heal through the tinue into their everyday lives. Emotions in EFT are considered trauma of infidelity, with sustained forgiveness and trust at the ‘‘music in the dance’’ (S. M. Johnson, 2004, p. 67). When 3-year follow-up. More recently, S. M. Johnson et al. (2013) therapists can help couples change the music (emotions), they demonstrated through an functional magnetic resonance imaging can change the dance (interactions; S. M. Johnson, 2004). (fMRI)-based hand-holding study that EFT can foster a loving The process of change in EFT consists of nine prescribed steps bond that comforts couples and soothes their threatened brain in within three stages, with the overall goal of forming a secure emo- the midst of potentially threatening stimuli, in addition to reduc- tional bond (S. M. Johnson, 2004). Stage I involves an overall ing the perception of or neutralizing previously arousing stimuli. assessment and de-escalation of the couple’s pernicious negative Additionally, EFT’s potential to become a powerful approach to interaction cycle. Stage II involves a shift from the couple’s rigid help couples traverse the trauma of terminal illness has been interactions toward new bonding experiences. Stage III, the final examined using a theoretical lens (Tie & Poulsen, 2013). stage, involves the consolidation of these changes and the integra- tion of new interactions in the couples’ everyday lives. EFT is one of the few empirically validated models for cou- EFT, Trauma, and Shame ples (S. M. Johnson, 2004). In a meta-analysis, S. M. Johnson, Although shame does not affect every person who has experi- Hunsley, Greenberg, and Schindler (1999) showed that approx- enced trauma, it has now been included in the criteria for PTSD imately 90% of couples who completed EFT reported having in the newly published DSM-5 (APA, 2013). Although it is more satisfying relationships than the average no-treatment con- mentioned only by name and not specifically detailed in the trol couple. DSM-5, shame can be one of the most difficult consequences of trauma, particularly when perpetrated maliciously by other human beings (Herman, 2011). According to Herman (2011), when shame becomes a central feature of a victim’s inner EFT and Trauma world, the posttraumatic condition can be thought of as a Trauma involves psychological damage in the midst of intense ‘‘shame disorder’’ (p. 262). Shame can be considered ‘‘the fear, helplessness, and horror, whether through personal or wit- default setting for insidious emotional trauma’’ (Cates, 2014, nessed experience of traumatic events (American Psychiatric p. 45). Shame is considered a key emotion that could exacer- Association [APA], 2013). Trauma causes an inner shift that bate PTSD and is an important
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